October 12, 2006

Q I passed out for a short time at a recent wedding reception. The meal was served at 9 pm, and I hadn’t eaten much since breakfast. The hosts insisted I go to the ER by ambulance. I spent a few hours there, and the doctor did tests and said I was fine. I heard someone mention hypoglycemia. What is it?

A Hypoglycemia is low blood sugar. If plasma glucose (blood sugar) drops very low – to less than 50 mg/dL (2.8 mmol/L) –– a number of symptoms can occur. As sugar drops, people feel quite shaky and often break out in a sweat. Their hearts race. They become confused and are overwhelmed by weariness. They might slip into unconsciousness or even have a seizure, but blood sugar has to be very low for either to happen.

A rare cause of hypoglycemia is a pancreatic tumour that makes too much insulin. It keeps producing insulin even in the face of a prolonged low blood sugar. The diagnosis is confirmed by checking the blood insulin levels after a person fasts for an extended period of time (one to three days).

A more common kind of hypoglycemia is due to the pancreas’ loss of the ability to fine tune its insulin releases. The pancreas releases too much insulin in response to a meal and doesn’t shut its release down quickly. A few hours later, blood sugar drops and people become symptomatic.

Both kinds of hypoglycemia are ended by eating something with sugar in it. The tumor requires surgery.

I can’t believe you had a hypoglycemic reaction. They last longer than a ‘short time’. They’re ended by eating something sweet. You weren’t given any sugar, were you? Furthermore, the doctors in the ER would not have sent you home without telling you that diagnosis and without insisting that you have a follow up with your doctor. It sounds more like you had a common faint. To be on the safe side, check with your doctor. He or she can get a copy of the ER report and let you know what the ER doctors did and their diagnosis.

Q What can you tell me about ‘borderline personality’? My cousin received this diagnosis. She and I grew up together, and she has always been peculiar. She definitely has been a loner and has never been able to hold on to a job. She has been very hard to get along with. She never married, and I believe it was because she is so hostile to people. Now I feel quite sorry for her, and I blame myself for not being kinder to her.

A Borderline personality is an illness where people have frequent mood swings. These people find it difficult to form close relationships. They prefer being alone. They also tend to act impulsively. Holding a job is a problem for many.

When these people approach 30, many lose some of these negative traits, but the rest have to contend with them for life.

In a few instances, people with borderline personality have periods when they can’t distinguish between reality and what is happening in their imaginations. Such flights from the real world are usually brief.

Medicine and counseling can provide a productive life for many borderline personalities.

Why don’t you look your cousin up? You might be surprised at the changes that she has managed to make with treatment.

Q My daughter is pregnant for the first time. A routine ultrasound shows that the baby has something called truncus arteriosus. The doctor told her the baby would need an operation. What is this all about? We are terribly frightened.

A During foetal development, the heart and the blood vessels attached to it undergo great modifications. The fully developed heart has two large arteries ––– the pulmonary artery, which brings blood to the lungs, and the aorta, which brings blood to the rest of the body. With truncus arteriosus, there is a single artery sprouting from the heart, and the partition between the right and left sides of the heart has a hole in it. Surgical correction of the defect is usually successful.

Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 328536475. Readers may also order health newsletters from www.rbmamall.com

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